Shima Taiki, Okumura Akihisa, Kurahashi Hirokazu, Numoto Shingo, Abe Shinpei, Ikeno Mitsuru, Shimizu Toshiaki
Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Japan.
Department of Pediatrics, Aichi Medical University, Japan.
Brain Dev. 2019 Mar;41(3):263-270. doi: 10.1016/j.braindev.2018.11.001.
Norovirus is a major pathogen of gastroenteritis and is known to cause encephalitis/encephalopathy. The aim of this national survey was to clarify the clinical features of norovirus-associated encephalitis/encephalopathy (NoVE) among children in Japan.
A nationwide survey of children with NoVE was conducted using a structured research form. The initial survey asked pediatricians about children with NoVE treated between January 2011 and March 2016. The second survey obtained patient information from two sources: hospitals that responded to the initial survey and those identified as having treated cases from a literature search.
Clinical information was available for 29 children. Their median age was 2 y 8 m. The outcome was good in 13 patients and poor in 15. The interval between the onset of gastrointestinal symptoms and that of encephalitis/encephalopathy was significantly shorter in those with a poor outcome. At the onset of an elevated serum creatinine level and an abnormal blood glucose level were correlated with a poor outcome. Regarding the subtypes of encephalitis/encephalopathy, acute encephalopathy with biphasic seizures and late reduced diffusion and hemorrhagic shock and encephalopathy syndrome were frequent.
The outcome of children with NoVE was poor. Early onset of neurological symptoms, an elevated serum creatinine level, and an abnormal blood glucose level were associated with a poor outcome. No effective treatment was identified and this should be the subject of future studies.
诺如病毒是肠胃炎的主要病原体，已知可引起脑炎/脑病。这项全国性调查的目的是阐明日本儿童中诺如病毒相关脑炎/脑病（NoVE）的临床特征。
使用结构化研究表格对患有NoVE的儿童进行全国性调查。初步调查询问儿科医生2011年1月至2016年3月期间治疗的患有NoVE的儿童情况。第二次调查从两个来源获取患者信息：对初步调查做出回应的医院以及通过文献检索确定为治疗过病例的医院。
有29名儿童的临床信息可供分析。他们的中位年龄为2岁8个月。13例患者预后良好，15例预后不良。预后不良的患者中，胃肠道症状发作与脑炎/脑病发作之间的间隔明显更短。血清肌酐水平升高和血糖水平异常与预后不良相关。关于脑炎/脑病的亚型，伴有双相性惊厥的急性脑病、晚期弥散受限和出血性休克及脑病综合征较为常见。
NoVE患儿预后不良。神经系统症状的早期出现、血清肌酐水平升高和血糖水平异常与预后不良有关。未发现有效的治疗方法，这应是未来研究的主题。
